In the Allegheny study, researchers found that most people who went through the MHC "tended not to return . . . to jail," Engberg said. A corollary benefit of MHC programs, he added, may be that they reduce jail/prison overcrowding and free jail space for more violent offenders.
Despite the promise of MHCs, Engberg noted that several factors can limit their growth. There are upfront costs to establishing MHCs. Already overloaded district attorneys' offices and the courts must find time to coordinate with community-based mental health treatment providers to create an MHC. In addition, he pointed out, establishing an MHC can be politically risky. If an MHC participant were to commit a terrible crime, there could be a high price to pay politically by government officials, politicians, and others who supported the court's establishment.
Daniel W. Shuman, M. D. Anderson Foundation Endowed Professor of Health Law at Southern Methodist University, noted that many of the judges on the ground floor of the MHC movement wrote chapters for Judging in a Therapeutic Key: Therapeutic Jurisprudence and the Courts.5 The book describes the newly emerging problem-solving courts (drug treatment courts, domestic violence courts, MHCs) and the principles of therapeutic jurisprudence that ap-pear to be at work in successful judicial approaches.
"My limited first-hand experience is that these courts are a function of the judge's style; no 2 are quite the same," Shuman added.Other studies and approaches
Since MHCs are relatively new, studies on their effectiveness are still emerging.6-8 Engberg noted that studies are under way that examine participant characteristics and outcomes. Allison Redlich, PhD, a senior research associate with Policy Research Associates, said that organization is conducting 2 studies, the MacArthur Mental Health Court study and the National Science Foundation (NSF) Mental Health Court Study.
The NSF study seeks to examine MHC defendants' perceptions and comprehension of court processes and requirements using pilot data from the Bronx, NY, MHC to validate newly developed instruments; they are also using 200 interviews with MHC defendants from the Brooklyn, NY, MHC and Washoe County, Nevada, MHC coupled with standardized assessments; and 1-year outcome data derived from record reviews and court charts.
The MacArthur study seeks to determine whether participation in MHCs (as compared with treatment as usual) leads to better access to mental health and substance abuse treatment in the community, and in turn, whether increased access leads to more favorable outcomes, such as improved quality of life and lowered recidivism. Self-report data will come from 140 MHC clients and 140 jail inmates at sites in California, Minnesota, and Indiana.
Phase 2 of the NSF study (interviews) is complete, and preliminary results from both studies should be available in a year or so, Redlich told Psychiatric Times.
In addition to MHCs, researchers, along with federal, state, and local officials, are looking at multiple points at which mentally ill individuals can be intercepted and diverted from the criminal justice system: crisis intervention teams; prebooking jail diversion programs; specialty courts; reentry from jails, prisons, and forensic hospitalization; and community corrections and community support.9 Last year, the Substance Abuse and Mental Health Services Administration awarded $7.2 million for jail diversion grant programs in 6 states.10
This November 14 to 16, the Allegheny County Department of Human Services' Office of Behavioral Health and the University of Pittsburgh's Center on Race and Social Problems, along with other agencies and organizations, are sponsoring the national conference, "Which Way Out? Applying the Sequential Intercept Model as a Framework for Decriminalizing Mental Illness," in Pittsburgh. Speakers will include the developers of the sequential intercept model Patricia Griffin, PhD, senior consultant for the National GAINS Center for People with Co-occurring Disorders in the Justice System and the Philadelphia Department of Behavioral Health, and Mark Munetz, MD, chair of the department of psychiatry at Northeastern Ohio Universities College of Medicine and chief clinical officer of the Summit County Alcohol(Drug information on alcohol), Drug Addiction, and Mental Health Services Board. Another speaker will be Pete Earley, author of Crazy: A Father's Search Through America's Mental Health Madness.11 For more information, contact Sue Martone, assistant deputy director of the Office of Behavioral Health for Allegheny County Department of Human Services, at: email@example.com.